ObjectiveSurgical radiofrequency (RF) ablation has recently been one of the most effective means to treat chronic atrial fibrillation(AF).However,about 20％ to 30％ patients have shown recurrence of AF during the follow-up period.This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years.We compared the information and clinical date in the sinus rhythm(SR) group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges.MethodsFrom June 2006 to June 2009,52 patients with rheumatic heart disease (RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method.Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided all patients to the SR grope and AF grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.Results There was only one case in-hospital mortality ( 1.9％ ).None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months (9-35 months).At the last follow-up,sinus rhythm was shown in 71.2％ (37/52) patients.In univariaye analysis,the left atrial diameter,AF duration,left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF.Age,left ventricular ejection factor,cardiopulmonary bypass time showed no significant difference between the two gropes.Multivariate analysis showed that AF duration was the independent risk factor of recurrence of AF after the bipolar radiofrequency ablation procedure.ConclusionRF ablation concomitant with valve replacement is an effective way to treat AF for those patients who need open heart surgery at the same time.Patients with normal SR may gain a better life quality.Preoperative duration of AF was the independent risk factor of AF recurrence.The longer the duration of AF is,the worse the efficacy of this procedure to restore normal SR is.

Establishing medical service payment system reform organization of diagnosis related groups and prospective payment system(DRGs-PPS) based on the theory of matrix management and learning organization.Firstly joint committee mechanism hasbeen established to guide the implementation of DRGs-PPS with the strong support of Beijing local government; Secondly series of related technical standards and organizational systems including AP-DRGs,AR-DRGs Group,Data Dictionary,ICD Group,International Classification of Surgical Operations Group,Pricing Classification Group,Training Group,Supervision Group,Support Group,Data Validation Group,BJ-DRGs Group have been created to support standard maintenance,project inspection and data analysis; Furthermore,learning organization has been realized by setting up various project groups and the establishment of DRGs-PPS platform help ensure performance evaluation of healtheare institutions and payment system reform.

Twenty inadequately controlled diabetic patients treated with insulin therapy received dapagliflozin treatment for 12 weeks. HbA1C, glycemic variations, plasma 8-iso-prostaglandin F2α(8-PGF2α), and hypersensitive C-reactive protein (hs-CRP) levels, the change of the insulin dose, and the safety of treatments were analyzed. The results showed that after 12-week dapagliflozin therapy, HbA1C, fasting plasma glucose, postprandial 2h plasma glucose, inter-quartile range, standard deviation of blood glucose, large amplitude glycemic excursions, postprandial glucose excursion, as well as absolute means of daily difference were significantly decreased ( P<0. 01) . Compared with those before treatment, addition of dapagliflozin notably decreased plasma 8-PGF2αand hs-CPR levels, along with reduced insulin dosage ( P<0. 01 ) and decreased body weight of patients ( P<0. 05 ) . After dapagliflozin treatment, the hypoglycemia of the patients was obviously improved, without report of severe hypoglycemia. These results indicate that dapagliflozin treatement improves glucose metabolism,and reduces insulin dosage and the hypoglycemic events in fragile diabetics with intensive insulin therapy.

Objective To improve overall value of healthcare industry through setting up critical inpatient medical services strategic plan.Methods Identify major objectives which the local government expects to achieve through strategic map; Standardize inpatient output and assign weight to each group through diagonosis related groups; Translate the objectives of strategic map and result of diagnosis related group to Balanced Score-card; Finally build up strategic map and according action plans.ResultsPreliminarily established 16 objectives、23 measures and 13 tasks in four perspectives including customer,internal work flow,learning and growing and finance.ConclusionThe strategy map and the balanced score-card can help implement full strategic plan of regional inpatient medical services; DRGs is a core management tool of patient-centred service output management; Balanced Score-card is able to realize continuous improvement of Beijing inpatient medical services from macro to micro persoetive.

OBJECTIVE: To investigate the differential expression of miR-126-5p in patients with lung adenocarcinoma and explore the possible mechanism. METHODS: We searched STARBASE database to analyze the differential expression of miR-126-5p between lung adenocarcinoma tissues and normal lung tissues. The prognosis of patients with lung adenocarcinoma was analyzed on Kaplan-Meier Plotter online website, and the survival curves of the patients with different expression levels of miR-126-5p were generated. The target gene of mir-126-5p was predicted by STARBASE database, and the expression level of the target gene and its influence on the patients' prognosis were analyzed using online website tool. We also examined the expression levels of miR-126-5p in peripheral serum of 30 healthy control subjects and 30 patients with lung adenocarcinoma using qPCR. RESULTS: Analysis of the data from STARBASE database showed a high expression of miR-126-5p in normal lung tissues but a low expression in lung adenocarcinoma tissues. Kaplan-Meier Plotter online analysis based on big data analysis showed that patients with a high expression of miR-126-5p had a better survival prognosis than those with a low expression (HR=0.68, =0.015). MiR-126-5p was predicted to bind to the 3'UTR region of BRCC3 mRNA, and their expression levels were negatively correlated (=0.197, < 0.05). Compared with normal tissues, lung adenocarcinoma tissues expressed high levels of BRCC3, which was associated with a poor prognosis of the patients (HR=1.39, < 0.05). The serum level of miR-126-5p was significantly higher in healthy control subjects than in patients with lung adenocarcinoma (1.23 ± 0.21 0.63 ± 0.12, < 0.05). CONCLUSIONS The expression level of miR-126-5p is lowered in lung adenocarcinoma tissue, and patients with lung adenocarcinoma have lower serum level of miR-126-5p than healthy subjects. A high expression of miR-126-5p is associated with a more favorable prognosis of the patients than a low expression. miR-126-5p may play a role against cancer by regulating BRCC3.

Objective: To investigate the synergistic lethal effect and mechanism of arsenic trioxide (ATO) and aclacinomycin (ACM) on human acute myeloid leukemia cell line KG-1a. Methods: Colony-forming assay was used to detect the proliferation of KG-1a cells treated with different concentration of ATO and ACM. Compusyn software was used to analyze the synergistic effect of ATO and ACM. Flow cytometry and Wright's staining were used to analyze the apoptotic rate of KG-1a cells induced by combined treatment of ATO and ACM. Western blot was used to determine the expression of proteins associated with apoptosis. Results: The cytotoxicity of arsenic trioxide or aclacinomycin alone was in a dose-dependent manner. Flow cytometry analysis showed that the apoptotic rate of KG-1a cells treated with both 0.4 μmol/L ATO and 10 nmol/L ACM was (34.5±3.1)%, significantly higher than (7.6±1.1)% of 0.4 μmol/L ATO treatment or (18.7±2.3) % of 10 nmol/L ACM treatment alone (P<0.05). The apoptotic rate of KG-1a cells treated with both 1.5 μmol/L ATO and 37.5 nmol/L ACM was (52.5±4.7)%, significantly higher than (19.1±3.2)% of 1.5 μmol/L ATO treatment or (27.7±2.2)% of 37.5 nmol/L ACM treatment alone (P<0.05). The apoptotic rate of KG-1a cells treated with both 3.0 μmol/L ATO and 75 nmol/L ACM was (61.3±4.5)%, significantly higher than (29.5±2.5)% of 3.0 μmol/L ATO treatment or (28.6±3.4) % of 75 nmol/L ACM treatment alone (P<0.05). In addition, the result of Wright's staining showed that combined treatment of ATO and ACM induced a more apparent phenotype of apoptosis when compared with single agent treatment. Compusyn software analysis showed that the combination index (CI) value of combined treatment group was less than 1, which indicated the synergistic effect of these two agents. Conclusions Combined treatment of ATO and ACM shows a synergistic lethal effect on human acute myeloid leukemia cell line KG-1a via activating the apoptotic pathway, which inhibits cell growth and induces apoptosis.

AIM: To study the distribution of CYP2C9∗3 and VKORC1-1639G>A gene polymorphism in Han population in Anhui province and their influence on the stable dose of warfarin. METHODS: The blood samples of 1 169 patients from 6 tertiary general hospitals in 5 areas of Anhui province from January 2020 to December 2021 were selected, the genotype of CYP2C9∗3 and VKORC1-1639G>A was detected by fluorescent staining in situ hybridization technique. RESULTS: The distribution of CYP2C9∗3 genotypes in 1 169 patients: the frequencies of AA, AC and CC genes were 90.16%, 9.24% and 0.60%, respectively; The distribution of VKORC1 genotype: the frequencies of AA, AG and GG genes were 84.26%, 14.71% and 1.03% respectively; There was no significant difference between the two genotypes in gender, age and regional distribution (P>0.05). The average daily warfarin dose of CYP2C9∗3 AA genotype in 755 patients with stable warfarin dose was (3.02±0.59) mg/d, which was significantly higher than patients with AC genotype and CC genotype; The average daily warfarin dose of patients with VKORC1-1639AA genotype was (2.72±0.40) mg/d, which was significantly lower than that of patients with AG genotype and GG genotype (P<0.05). And the difference was statistically significant (P<0.05); There are significant differences in gender, age and clinical diagnosis between patients with stable dose of warfarin and those without stable dose (P<0.05). CONCLUSION: CYP2C9 and VKORC1 genotypes are associated with the stable dose of warfarin. Clinical anticoagulation therapy guided by CYP2C9 and VKORC1 genotypes can provide guidance for individualized medication of warfarin.